Tracheostomy care

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Tracheostomy
Care
Shemil
Clinical Instructor
DM WIMS

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Tracheostomy Care & Management

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Objectives
1.Review of Evidenced-Based Guidelines in the Care &
Maintenance.
2.Review Definition, Types of Tracheostomies & their
uses.
3.Potential Complications.
4.Nursing Care.
5.Assessment.
6.Suctioning.
7.Dressing changes.
8.Inner cannula changes.
9.Other nursing considerations.
10.Documentation in powerchart.

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Definitions
Tracheotomy
Incision made below the cricoid cartilage through the
2nd-4th tracheal rings.
Tracheostomy
The opening or stoma made by this incision.
Tracheostomy Tube
Artificial airway inserted into the trachea.

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Anatomy

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Why does your patient have a tracheostomy?
To maintain a patent airway when the ability to do
this is temporarily or permanently compromised
Bypass Obstructed airway
a) Tumor
b) Laryngeal edema
c) Foreign body obstruction
Facilitate removal of secretions
Permit long-term ventilation/prevent aspiration with
prolonged coma
Decrease work of breathing---severe COPD

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Parts of a Trach
1. Flange- secured with trach ties, stabilizes the trach.
2. Outer Cannula-tube connected to flange.
3. Inner Cannula- removable for cleaning.
4. Obturator-a plastic guide with a smooth rounded tip
that is used to guide the outer cannula during insertion.
5. Cuff-Soft balloon around the end of the trach that
can be inflated to allow for mechanical ventilation.

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Types
1. Cuffed or Un-cuffed
2. Fenestrated or Non-fenestrated
3.Disposable or Non-disposable inner cannula
4.Metal Tubes

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Cuffed
Purpose:
• Increase or improve ventilation/oxygenation
•Prevent aspiration with feeding tubes, decreased
gag reflex, gastro-esophageal reflux
Identification:
DCT- disposable cannula
DFEN- disposable cannula fenestrated

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Cuff Complications
Pressure from the cuff can cause damage the trachea
 Necrosis
 Low pressure cuffs are used
 RT will inflate/deflate and monitor pressure

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Un-cuffed
Plastic or metal
Allows air to flow freely around the tracheostomy tube
through the larynx.
 Reduces the risk of tracheal damage

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Fenestration
Permits speech through the upper airway when the
external opening is corked and the cuff is deflated.
Restores more of a normal airflow by allowing air
to pass up and down the airway from the nose &
mouth.
 Allows secretions to be coughed out through mouth.

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Inner Cannula
Allows maintenance of tube patency.
Changing or cleaning the inner cannula helps to clear
secretions.
Can be non-disposable or disposable.

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Potential Complications
 Hemorrhage
 Pneumothorax
 Subcutaneous emphysema
 Dislodged tube
 Airway obstructions
 Infection
 Aspiration
 Tracheal damage

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Prevention is Key
Trach patients are at high risk for airway obstructions,
impaired ventilation, and infection as well as other
complications.
Altered body image, requiring emotional/psychological
support.
 Skilled and timely nursing assessment and care can
prevent these complications.
Goals in care will include maintaining a patent airway
as well as ventilation/oxygenation:
 Suctioning
 Humidity
 Trach care & maintenance

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Nursing Assessment
Beginning of each shift and prn.
Look and listen.
Vital signs & SpO2 – pulse oximetry.
 Oxygen/Humidity.
 Respiratory assessment = breath sounds.
 Secretions- amount, color, consistency.
 Cough, ability to clear own secretions.
 Trach site.

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TRACHEOSTOMY
CARE

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Changing/Cleaning Inner Cannula
Non-disposable inner cannulas are cleaned with Normal
Saline,diluted hydrogen peroxide, rinsed off with N/S
remove excess fluid before re-inserting

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 Disposable inner cannulas are replaced with trach
care Q8 hours & PRN
 Trach ties-are changed only when wet or soiled
and 2 people should assist with this procedure---
Leave one finger between ties and neck--Velcro
hooks attach easily to tracheostomy tube flange.

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SUCTIONING

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Decision to Suction
Frequency of suction will vary and must be
individually assessed & not done on a schedule
Factors to Consider:
Is the pt able to cough &/or clear secretions?
 Increased work to breath?
 Changes to respiratory rate
 Amount and consistency of secretions
 Decreased O2 saturation
 Secretions are audible
 Pt request
 Other Respiratory S & S (i.e. SOB, cyanosis,
restless,anxiety)

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Suctioning
Insert catheter until you meet resistance &/or pt coughs
forcibly then pull back slightly &start suctioning

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Procedure Considerations
Suctioning removes secretions, & also O2
Suction pressure too high (>120mmHg) can cause
mucosa damage & bleeding.
Suction pressure too low may not clear secretions & be
ineffective
Suction mouth with a (yankauer) not the same suction
catheter as trachea to avoid cross contamination
 Do not apply suction while inserting the catheter
May be necessary to pre-oxygenate the patient prior to
and after suctioning
Use personal protective equipment (i.e. goggles,
mask,face shield)

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Suctioning
Pre oxygenation
Test suction pressure before instilling catheter 60-120 mm Hg
Suction catheter: £ ½ diameter of tube
Prepare clean cup with NS to lubricate and clear secretions from
suction catheter
Dominant hand remains sterile with clean glove, and will be
inserting the catheter, while the non-dominant gloved hand grasps
the suction port
Apply suction only on removal of catheter no during insertion
Suction efficiently and quickly depending on secretion
amount,consistency.
Each suction should not exceed more than 10 seconds
Do not exceed 3 attempts and allow 20 to 30 seconds between
each, oxygenate pt between PRN

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 Post oxygenation
 Replace all the articles
 keep ready articles for next suction
 Wash hands
 Document the procedure.
 Continue patient assessment.

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Complications with Suctioning
Hypoxemia—dysrhythmia
 Atelectasis or lung collapse
 Mucosal trauma/damage---bleeding
 Broncho spasm
 Dysrhythmias
 Nosocomial pulmonary tract infection
 Sepsis
 Cardiac arrest

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TRACHEOSTOMY
DRESSING

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CLOSED SUCTION

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